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Abdominal Confluence of Lymph Trunks: Detectability and Morphology on Heavily T2-Weighted Images

Ayse Erden1, Suat Fitoz1, Banu Yagmurlu1 and Ilhan Erden1

1 All authors: Department of Radiology, Ankara University, School of Medicine, Talatpasa Bulvari, Sihhiye, 06100, Ankara, Turkey.



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  		Fig. 1. —37-year-old man with elevated serum levels of cholestatic enzymes. Heavily T2-weighted axial MR image reveals ovoid (9 x8 mm) hyperintense signal immediately anterior to vertebral body, representing cisterna chyli. It is assumed to be located at midline if it is seen between lines passing from inner borders of vertebral pedicles. Right- or left-sided cisterna chyli is considered whenever duct is situated outside these lines.

 


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  		Fig. 2. —Intestinal trunk and lumbar lymphatic trunks in 35-year-old man with abnormal results on liver function tests. Heavily T2-weighted consecutive axial MR images show intestinal trunk (white arrow), which carries lymph from gastrointestinal tract at point at which it drains into cisterna chyli. This trunk can be seen piercing diaphragmatic crus (not shown) during its course from mesentery to retrocrural space. Bilaterally located paravertebral ovoid hyperintense structures are consistent with lumbar trunks (black arrows) draining lymph of lower extremities and pelvis.

 


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  		Fig. 3. —13-year-old boy with hereditary spherocytosis. Coronal maximum-intensity-projection image shows prominent lumbar trunks (arrows) lying bilaterally along paravertebral region. Note caudal extension of left lumbar trunk, which follows course of iliac vessels.

 


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  		Fig. 4. —37-year-old man with elevated serum levels of cholestatic enzymes. Coronal maximum-intensity-projection image shows cisterna chyli (arrow) as tubular structure at level of L1–2.

 


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  		Fig. 5. —52-year-old woman with abnormal results on liver function tests. Coronal maximum-intensity-projection image shows cisterna chyli (arrows) at level of T12–L2, lying slightly to right of midline in its course toward thorax. In its cephalic and caudal portion, network of small channels is present, giving duct plexiform appearance.

 


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  		Fig. 6A. —22-year-old woman with acute nonlymphocytic leukemia. Coronal maximum-intensity-projection (MIP) image shows cisterna chyli (arrow) lying in midline of spine at level of L1–3. Note high-signal intrahepatic periportal cuffing due to lymphedema.

 


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  		Fig. 6B. —22-year-old woman with acute nonlymphocytic leukemia. Sagittal MIP image shows hepatic lymphatic (curved arrow), which turns dorsally to empty into cisterna chyli (straight arrow).

 


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  		Fig. 7. —40-year-old woman with hydatid disease. Coronal maximum-intensity-projection image reveals alternating segments of dilatation and focal constrictions of lymphatic duct giving cisterna chyli (solid arrow) beaded appearance at level of L1–2. Note ureters (open arrows).

 


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  		Fig. 8. —53-year-old man with elevated serum levels of alkaline phosphatase and {gamma}-glutamyltransferase. Coronal maximum-intensity-projection image shows several branches of lymphatics joining slightly to left of aorta to form plexiform interlacement (arrows).

 

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